A new model of reversible obstructive jaundice using rapidly absorbable suture materials

Abstract

Purpose: Reversible obstructive jaundice models have some limiting features, including the need for a second anaesthesia, re-laparotomy and surgical intervention after common bile duct ligation. The present study investigates the feasibility of a new application that can eliminate these limitations. Rapidly absorbable suture materials were used for ligation; therefore, spontaneous biliary decompression was anticipated by the self release of these rapidly degrading materials. Methods: Common bile ducts in Wistar Albino rats were ligated with silk, polyglytone 6211, or irradiated polyglactine 910 (n=7 for each group). Rats were grouped according to both the suture materials and the experiments termination date: 5 days (sham, silk5, polyglytone5, polyglactine5) and 21 days (silk21, polyglytone21, polyglactine21) after the ligation. Biochemical and morphologic changes of liver were assessed. Results: The group polyglactine21 showed significantly lower mean ALT, AST, GGT, total and direct bilirubin values when compared with the group polyglactine5 (p=0.004-0.037). Morphologic changes did not correlate with the biochemical amelioration. In the group polyglytone21, not only the biochemical but also the morphologic changes significantly ameliorated when compared with the group polyglytone5 (p=0.003-0.043). No procedure associated mortality was observed. Conclusion: Common bile duct ligation with polyglytone offers a new reversible model for prolonged obstructive jaundice which abolishes the need for relaparotomy and a second surgical intervention and significantly reduces mortality.

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“…Some studies made use of Roux-en-Y choledochojejunostomy for drainage, which is a complex method and requires skilled operators [1415]. Kahramansoy et al [16] ligated the CBD with rapidly absorbable suture materials, and spontaneous biliary drainage was presented when these materials were degraded. This method faces a contradictory problem in that tight ligation may cause injury to the CBD in the second operation while loose ligation may fail to induce OJ.…”

“…In newly published articles, choledochoduodenostomy was still the prior internal drainage technique for many researchers [11718192021]. However, choledochoduodenostomy was not suitable in some studies because of high mortality and morbidity rates and poor stability [45916222324]. There are several common complications, such as bile leakage, biloma and tube dislodgement and blockage.…”